Place is defined as a social or environmental area of residence with meaning to a patient. We hypothesize there is an association between place and the clinical outcomes of lung transplant recipients in the United States. In a retrospective cohort study of transplants between January 1, 2010, and December 31, 2019, in the Scientific Registry of Transplant Recipients, multivariable Cox regression models were used to test the association between place (through social and environmental factors) with readmission, lung rejection, and survival. Among 18,465 recipients, only 20% resided in the same county as the transplant center. Recipients from the most socially vulnerable counties when compared to the least vulnerable were more likely to have COPD as a native disease, Black or African American race, and travel long distances to reach a transplant center. Higher local life expectancy was associated with lower likelihood for readmission (odds ratio [OR] = 0.90, 95% confidence interval [CI]: 0.84, 0.98, p = .01). Higher social vulnerability was associated with a higher likelihood of lung rejection (OR = 1.37, [CI]: 1.07, 1.76, p = .01). There was no association of residence with posttransplant survival. Recipient place-based factors were associated with complications and processes of care after transplant and warrant further investigation.

中文翻译：

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肺移植受者结果中基于地点的异质性

地点被定义为对患者有意义的社会或环境居住区域。我们假设美国肺移植接受者的地点与临床结果之间存在关联。在 2010 年 1 月 1 日至 2019 年 12 月 31 日期间移植接受者科学登记处的移植回顾性队列研究中，使用多变量 Cox 回归模型来测试地点（通过社会和环境因素）与再入院、肺拒绝, 和生存. 在 18,465 名接受者中，只有 20% 与移植中心居住在同一县。与最脆弱的社会相比，来自社会最脆弱县的接受者更有可能将慢性阻塞性肺病作为本土疾病，黑人或非裔美国人种族，长途跋涉到达移植中心。较高的当地预期寿命与较低的再入院可能性相关（比值比 [OR] = 0.90，95% 置信区间 [CI]：0.84，0.98，p  = .01）。更高的社会脆弱性与更高的肺排斥可能性相关（OR = 1.37，[CI]：1.07，1.76，p  = .01）。居住地与移植后存活率无关。基于接受者位置的因素与移植后的并发症和护理过程相关，需要进一步调查。